Live and Learn: Focusing on Blood Glucose

The Person

J.B., 45, had lived with type 2 diabetes for 12 years. He also had related health problems: coronary artery disease (he had a heart attack and a stent placement a few years after his diabetes diagnosis) and sleep apnea, in which his breathing was interrupted multiple times per night.

The Issue

After several years when J.B. controlled his diabetes with an eating plan, exercise, and metformin, his blood glucose levels started to rise. After the heart attack, he needed several pills and multiple daily insulin injections to manage his blood glucose. With this potent combination of medication, his A1C, a measure of average blood glucose levels over two to three months, eventually improved to the desired 6 to 7 percent range. But a job change, more travel, and weight gain eventually led to a significant increase, to 10.8 percent. He continued taking three kinds of oral diabetes medications, injecting insulin and exenatide (Byetta) as prescribed, tried to eat healthfully, and tested his blood glucose three to four times a week. His A1C improved somewhat but didn’t reach the healthy range of less than 7 percent, and he was obese. J.B. found it hard to exercise regularly and knew he was overeating. Extra pounds, uncontrolled blood sugars, and worries about his long-term health weighed him down. He wanted to explore options.

The Education Plan

I hoped to help J.B. see the effect of his food, exercise, and medications on his blood glucose levels. Just one meter reading a day failed to show the effect of a big meal, for example. I hoped that seven days of wearing a continuous glucose monitor, which shows glucose levels every few minutes, would help J.B. better understand the changes in his blood glucose, especially related to his food choices. Seeing the effects of his choices in real time on the CGM, and analyzing them with me using graphs of the data, could be powerful.

The Results

J.B. wore a CGM for seven days. It gave him the feedback he hoped for. J.B. bought a personal CGM (this device is often not covered for people with type 2 diabetes by insurance plans, including Medicare). After using his CGM for several months, J.B. achieved an A1C of 6.4 percent, needed substantially less insulin, and lost 15 pounds.

Takeaways

Your health care provider may be able to provide a loaner CGM or a professional device. If such a device is not available, talk to your diabetes educator about using your blood glucose meter and strips to test before and after meals and before and after exercise for a few days. This can help you and your provider see the effects of food, exercise, and medication on your blood glucose levels and consider the best actions to take.

Monica Joyce, MS, RD, LDN, CDE,is the program director of the American Diabetes Association–recognized diabetes program at Sobel Medical Associates in Chicago and coauthor of Too Busy to Diet. Note: She has served as a paid speaker for Dexcom, which manufactures CGMs.